Welcome to The ADHD Center of North Dallas!

Behavior Checklist for Adults


Please fill this form out completely. Select the number that indicates how frequently or how much each item describes you as a child (age 5-12).


0=Never 1=Rarely 2=Once in a While 3=Often 4=Almost Always

- 1.) I was easily distracted.
- 2.) I made careless mistakes or had trouble paying close attention details or make careless to details.
- 3.) I fidgeted (with my hands or feet) or squirmed in my seat.
- 4.) I had trouble keeping my attention focused at school or during fun activities.
- 5.) It was hard for me to sit still for long: I left my seat when I was not supposed to.
- 6.) I didn't listen when people spoke directly to me.
- 7.) I felt restless.
- 8.) I had trouble following through on instructions and failed to finish things I started.
- 9.) I was noisy and had difficulty doing things quietly.
- 10.) I had difficulty organizing tasks and activities.

0=Never 1=Rarely 2=Once in a While 3=Often 4=Almost Always

- 11.) I was always on the go, as if driven by a motor.
- 12.) I avoided, disliked, or was reluctant to engage in work that requires required sustained mental effort.
- 13.) I talked too much.
- 14.) I lost things necessary for tasks or activities (lists, pencils, cell phone, keys, books, tools, etc).
- 15.) I blurted out answers before questions had been completed.
- 16.) I had trouble awaiting my turn.
- 17.) I was forgetful in my daily activities.
- 18.) I interrupted or intruded on others accidentally.

Checklist By Richard Cowles, PsyD. Designed for the ADHD Center of North Dallas 2009.